Are my gastrointestinal problems HIV realted?

[zatov9]

Hello Doctor,

I'm a gay male, in good health/oral and otherwise, who is not promiscuous but stupidly decided "at age 45 that he would break out of his shell instead of being such a prude " and about 7 weeks ago I had the last of four sexual encounters where I gave and received unprotected oral sex to men of unknown HIV status. On two of those encounters the men surprised me by ejaculating in my mouth (which I spit out quickly).  I've seen here that this carries only a very small HIV risk- which relieves me. My main problem, aside from great anxiety and depression over this whole incident, is that  since my last sexual encounter I've developed constant gastrointestinal problems. My gastro problems began shortly after I started to worry about my sexual encounters. Since that time my stomach problems have progressed from mild cramps to occassional mild/moderate stomach pains and to very frequently having to go to the toilet shortly after a meal with diarrhea- which has caused me to loose 15 pounds. I went to see a doctor about my anxiety as well as my situation and he prescribed Klonopin .5mg twice a day as well as Librax twice a day for my gastro issues. The meds help somewhat but not completely. Aside from my gastrointestinal issues- which really worry me, I have NOT had any major ARS symptoms like: fatigue, fever, rash, sore throat or flu like symptoms. For the first couple of weeks, however, I did feel some tenderness/tingling of both glands underneath my jaw and I had about a week of mild/mod testicle pain as well. I guess my questions to you are: 1.Do you think my gastrointestinal problems are HIV related or anxiety related, and 2. From all of the questions you get have you ever had someone had gastrointestinal problems like mine for the entire 12 weeks until they got tested? , 3. Can you please provide me with any additional insights- I literally going crazy with anxiety.

Thank you so much,

Terrified in Miami

[Edward W Hook, MD]

Thanks for the clarification.  The reason I asked is sometimes with rectal contact small amounts of fecal material can be transmitted to the mouth and cause infection this way.

As I said, I am confident your symptoms are not due to HIV.  HOWEVER, if your symptms have now persisted for 7 weeks and are getting worse, you should go see your doctor.  He/she will take a more complete history, examine you and, I suspect, do some tests.  This should be evaluated.  EWH

[zatov9]

Sorry about the "Why isn't my question being answered? " comment. Its just that I had not seen an answer yet.

There was no oral/rectal activity like rimming or anything like that. I have had protected anal sex with a condom and plenty of lube but did not mention it because a condom was used. Thanks for your quick response, let me know your impressions.

Also, over the past 7 weeks the symptoms have been getting progressively worse. When I eat small meals its better. If I drink liquids like coke or water there is no problem. Usually, I can tolerate food better in the evenings.

Thanks again,

Let me know what you think.

[Edward W Hook, MD]

Welcome to the Forum.  Just to be sure, in addition to unprotected oral sex, I want to verify that there was no rectal sex involved.  The reason I ask this is that if there was, there are a number of different organisms which can cause diarrhea which are passed by direct or indirect oral-rectal contact.  

As far as your HIV risk. it is virtually zero.  As we have said time and time again on this site, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  In your case, you don't even know that any of your partners had HIV.


As far as can anxiety affect the GI tract and cause diarrhea? - the answer is unequivocally yes.  The fact that treatment for your anxiety has helps also supports this as a possible cause of your diarrhea.

Finally, I would urge you not to bother to wait until 3 months for testing.  It has now been nearly 8 weeks since your last exposure.  At test performed at this time would detect virtually all HIV infections acquired 8 or more weeks before.  Given the low risk nature of your exposure, an 8 week test can be taken as evidence that you do not have HIV and have no reason for further testing or for worry.

Hope this helps.  EWH